A complication after an acute stroke, pervasive but largely overlooked, is that you can no longer step outside of yourself to empathise with others. I truly wish I had been able to feel my son’s pain, who stayed with me all day every day in hospital; and my daughter’s anguish, who was in Israel on a year’s long program.
Recently my son said it would be too painful to relive our traumatic experience through these blogs. I had a similar experience. When I was thirty-three, I lived with my mother during the last seven months of her terminal illness. My mother was living alone at the time, my father having died two years before. Tragically, my older and only sibling died when I was fourteen, so there was no one else to support my mother in her battle with cancer. Nonetheless I was hugely grateful to have the opportunity to help her to stay in her own home, where she died.
My mother told me she pitied me for my sorrow as she declined, rather than herself. Till the very last, she was able to articulate her feelings. Unlike her, after my brain injury I could not share my feelings with my children and friends; indeed, I could not share anything nor appreciate how my stroke was impacting others. This is not a character flaw to be tackled by a therapist; it belongs in the province of a neurologist or neuroscientist. It is a disorder.
I believe that empathy is a truly human mental state – to place yourself in another person’s shoes, sometimes called shoe-shifting. It is an extraordinarily sophisticated cognitive task, to marry the dissimilar parts of your brain, emotional and cognition processes: incorporating feelings, thoughts, desires, beliefs, memory; to comprehend another person’s emotional state, and interpret their actions. Shoe-shifting is almost unattainable for a person recovering from an acute stroke.
Psychodrama is an experiential therapy for shoe-shifting. At twenty-eight I joined a psychodrama group, a group of fifteen who stayed together for five years. “Put yourself in other participants’ shoes” is at the heart of psychodrama. Participants recreate a drama in their lives, but seeing it from another participant’s perspective, using techniques like mirroring and role reversal. Sometimes the drama unfolds in utterly unpredictable ways. I once initiated a drama in the group to articulate my feeling of foreboding. I used an inanimate animal to elicit the drama because my fears felt like an animal was gnawing at me. We thought it would be a werewolf or an underworldly creature; as the drama unfolds, instead it turned out to be a gentle, very helpful and particularly protective big brown bear.
This is how I learnt to concretise my feelings. So, when I started seeing my therapist after my stroke, a Freudian not a Psychodramatist, he asked how I saw myself in these early days after my stroke. I drew a crude picture of my brain, as a volcano in my head, plugged by rock falls caused by a heart clot, the pressure building beneath until it exploded in my brain. Boom.
Playwright David Mamet said an audience in the theatre responds to a drama to the extent it parallels the audience unshared feelings. I think that’s why people go to the theatre – we love to see actors exposing feelings that are entirely familiar to the audience that they would never, never reveal. Unlike a play, in psychodrama the “actor” gets immediate feedback, sometimes brutal.
I had no feedback mechanism. I did not reflect on the impact of my illness on anyone else. It walls us off from other people, even those in our circle – family, friends, tribes. A brain injury is an empathy disorder.